Whether or not any attempt should be made to improve matters depends largely on the degree of deformity and the amount of interference with function. When interference is called for, if the callus is not yet firmly consolidated, it may be possible, under an anæsthetic, to bend the bone into position or to re-break it, either with the hands or by means of a strong mechanical contrivance known as an osteoclast. In the majority of cases, however, an open operation yields results which are more certain and satisfactory. When the deformity is comparatively slight, the bone is divided with an osteotome and straightened; when there is marked bending or angling, a wedge is taken from the convexity, as in the operation for bow-leg. To maintain the fragments in apposition it may be necessary to employ pegs, plates, bone-grafts, or other mechanical means. Splints and extension are then applied, and the condition is treated on the same lines as a compound fracture. [Illustration: FIG. 5.--Multiple Fractures of both Bones of Forearm showing mal-union.] #Delayed Union.#--At the time when union should be firm and solid, it may be found that the fragments are only united by a soft cartilaginous callus, which for a prolonged period may undergo no further change, so that the limb remains incapable of bearing weight or otherwise performing its functions. The normal period required for union may be extended from various causes. The most important of these is general debility, but the presence of rickets or tuberculosis, or an intercurrent acute infectious disease, may delay the reparative process. The influence of syphilis, except in its gummatous form, in interfering with union is doubtful. The influence of old age as a factor in delaying union has been overestimated; in the great majority of cases, fractures in old people unite as rapidly and as firmly as those occurring at other periods of life. _Treatment._--The general condition of the patient should be improved, by dieting and tonics. One of the most reliable methods of hastening union in these cases is by inducing passive hyperæmia of the limb after the method advocated by Bier, and this plan should always be tried in the first instance. An elastic bandage is applied above the seat of fracture, sufficiently tightly to congest the limb beyond, and, to concentrate the congestion in the vicinity of the fracture, an ordinary bandage should be applied from the distal extremity to within a few inches of the break. The hyperæmia should be maintained for several hours (six to twelve) daily. An apparatus should be adjusted to enable the patient to get into the open air, and in fractures of the lower extremity the patient should move about with crutches in the intervals, putting weight on the fractured bone. This method of treatment should be persevered with for three or four weeks, and the limb should be massaged daily while the constricting bandage is off.